Speaker Name: Stephanie Tzarnas
Category: (Speaker/Oral Presentation)
Track name: Track 14: Gastrointestinal Surgery Research
Research interest: pancreatic disorders, motility
S. Tzarnas1
, S. Elrod2
, M. Kramer3
, D. Ringold4
Biography: Stephanie completed her medical degree from Drexel University College of Medicine in Philadelphia, PA. She is currently an internal medicine resident at Jefferson-Abington Health. She is interested in pursuing a gastroenterology fellowship in the future
Global Journal of Gastroenterology & Hepatology Research [GJGHR]
Introduction: Necrotizing pancreatitis is a rare complication that can occur after cholecystectomy. Specifically, patients who are pregnant are at greater risk for acute cholecystitis and the consequences can be deadly. We present a rare case of Necrotizing Pancreatitis secondary to acute cholecystitis in a post partum female.
Case: A 27 year-old female, three weeks postpartum, presented to the emergency room with intractable abdominal pain. Abdominal ultrasound demonstrated acute cholecystitis and the patient was taken for urgent laparoscopic cholecystectomy. Twelve hours after surgery, she developed diffuse abdominal pain, tachycardia, and tachypnea. A CT scan revealed a large intra-abdominal fluid collection. She was emergently taken to the OR for exploratory laparotomy and abdominal wash out. Intraoperatively, she was found to have a swollen retroperitoneum without bile leak but with necrotizing pancreatitis. Intraabdominal drains were placed and she was started on empiric antibiotics. She was discharged on total parenteral nutrition with an ongoing discussion regarding a pancreatic necrosecto my in the future.
Discussion: Necrotizing pancreatitis is a rare and dangerous form of pancreatitis. The presentation following an acute cholecystitis status-post laparoscopic cholecystostomy is even less common. The mechanism of injury is unknown and could be secondary to inflammation in the area surrounding the peritoneum given the pancreas’s proximity to the inflamed gallbladder, possible transient stone translocation, or the injury that accompanies surgical interventions such as cholecystectomies. Clinicians should be aware of this complication when evaluating patients both for acute cholecystitis and pancreatitis. If careful attention is not paid during this period, mortality rates can be high with infection. Adequate fluid resuscitation is pivotal in the first 48 hours as the rate of vascular leak syndrome and massive fluid loss via third spacing is highest early on. Evaluation for antibiotics is also critical as nearly one-third of patients with necrotizing pancreatitis can have infected tissue.
Keywords: necrotizing pancreatitis, acute cholecystitis
References: [1] Singh V.K. et al. (2011). Clinical Gastroenterology and Hepatology, 9:1098. [2] Schepers N.K. et al. (2020). Lancet, 396:167. [3] Raty, S. et al. (2015). Annals of Surgery, 262:736.
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